Minimally invasive internal fixator for unstable pelvic ring injuries with a pedicle screw–rod system: a retrospective study of 23 patients after 13.5 months
Tóm tắt
Pelvic ring fractures are challenging injuries and require effective treatment due to the frequently compromised patient condition. The aim of this study was to evaluate the outcome of unstable pelvic ring injuries treated with a minimally invasive pedicle screw–rod system. Retrospective analysis was performed for patients with an unstable pelvic ring injury that were treated with a minimally invasive anterior internal pelvic fixator (INFIX) with or without a posterior pedicle screw–rod fixator (6/2012–4/2015). The quality of reduction was evaluated by the Tornetta and Matta criteria and the clinical outcome was evaluated by the Majeed scores. Further evaluation included the operation time, intraoperative blood loss, and complication rate. A total of 23 patients (12 males and 11 females) with a mean age of 37.6 years (range 10–65 years) and a follow-up of 13.5 months (6–27 months) were evaluated. The Tile classification showed 13 type B (B1 = 6, B2 = 4, and B3 = 3) and 10 type C (C1 = 7 and C2 = 3) fractures. Mean operation time and intraoperative blood loss were 24.8 min (20–30 min) and 20.4 ml (16–29 ml) for an anterior INFIX (n = 13), and 60 min (45–70 min) and 150 ml (115–168 ml) when combined with a posterior pedicle screw–rod fixator (n = 10). Quality of reduction was excellent in 13, good in 6, and fair in 4 patients, with no signs of heterotopic ossification. Clinical results after 6 months were excellent in 14 patients, good in 6, fair in 2, and poor in 1. Unilateral thigh paresthesia was seen in 2 patients which resolved after implant removal. The INFIX appears to be a safe and minimally invasive surgical technique which can effectively be combined with posterior pedicle screw–rod fixation. It also can be applied for the definitive treatment of vertically and/or rotationally unstable pelvic ring injuries, especially in severely compromised patients with a high mortality risk.
Tài liệu tham khảo
Solomon LB, Pohl AP, Sukthankar A, Chehade MJ (2009) The subcristal pelvic external fixator: technique, results, and rationale. J Orthop Trauma 23(5):365–369. https://doi.org/10.1097/BOT.0b013e3181a2aec3
Kellam JF (1989) The role of external fixation in pelvic disruptions. Clin Orthop Relat Res (241):66–82
Miller PR, Moore PS, Mansell E, Meredith JW, Chang MC (2003) External fixation or arteriogram in bleeding pelvic fracture: initial therapy guided by markers of arterial hemorrhage. J Trauma 54(3):437–443. https://doi.org/10.1097/01.ta.0000053397.33827.dd
Mason WT, Khan SN, James CL, Chesser TJ, Ward AJ (2005) Complications of temporary and definitive external fixation of pelvic ring injuries. Injury 36(5):599–604. https://doi.org/10.1016/j.injury.2004.11.016
Scaglione M, Parchi P, Digrandi G, Latessa M, Guido G (2010) External fixation in pelvic fractures. Musculoskelet Surg 94(2):63–70. https://doi.org/10.1007/s12306-010-0084-5
Tucker MC, Nork SE, Simonian PT, Routt ML Jr (2000) Simple anterior pelvic external fixation. J Trauma 49(6):989–994
Hupel TM, McKee MD, Waddell JP, Schemitsch EH (1998) Primary external fixation of rotationally unstable pelvic fractures in obese patients. J Trauma 45(1):111–115
Vaidya R, Colen R, Vigdorchik J, Tonnos F, Sethi A (2012) Treatment of unstable pelvic ring injuries with an internal anterior fixator and posterior fixation: initial clinical series. J Orthop Trauma 26(1):1–8. https://doi.org/10.1097/BOT.0b013e318233b8a7
Vigdorchik JM, Esquivel AO, Jin X, Yang KH, Onwudiwe NA, Vaidya R (2012) Biomechanical stability of a supra-acetabular pedicle screw internal fixation device (INFIX) vs external fixation and plates for vertically unstable pelvic fractures. J Orthop Surg Res 7:31. https://doi.org/10.1186/1749-799x-7-31
Vaidya R, Martin AJ, Roth M, Tonnos F, Oliphant B, Carlson J (2017) Midterm radiographic and functional outcomes of the anterior subcutaneous internal pelvic fixator (INFIX) for pelvic ring injuries. J Orthop Trauma 31(5):252–259. https://doi.org/10.1097/bot.0000000000000781
Vaidya R, Martin AJ, Roth M, Nasr K, Gheraibeh P, Tonnos F (2017) INFIX versus plating for pelvic fractures with disruption of the symphysis pubis. Int Orthop 41(8):1671–1678. https://doi.org/10.1007/s00264-016-3387-9
Hoskins W, Bucknill A, Wong J, Britton E, Judson R, Gumm K, Santos R, Sheehy R, Griffin X (2016) A prospective case series for a minimally invasive internal fixation device for anterior pelvic ring fractures. J Orthop Surg Res 11(1):135. https://doi.org/10.1186/s13018-016-0468-9
Vaidya R, Kubiak EN, Bergin PF, Dombroski DG, Critchlow RJ, Sethi A, Starr AJ (2012) Complications of anterior subcutaneous internal fixation for unstable pelvis fractures: a multicenter study. Clin Orthop Relat Res 470(8):2124–2131. https://doi.org/10.1007/s11999-011-2233-z
Fang C, Alabdulrahman H, Pape HC (2017) Complications after percutaneous internal fixator for anterior pelvic ring injuries. Int Orthop. https://doi.org/10.1007/s00264-017-3415-4
Wu XT, Liu ZQ, Fu WQ, Zhao S (2017) Minimally invasive treatment of unstable pelvic ring injuries with modified pedicle screw-rod fixator. J Int Med Res. https://doi.org/10.1177/0300060517715529
Hesse D, Kandmir U, Solberg B, Stroh A, Osgood G, Sems SA, Collinge CA (2015) Femoral nerve palsy after pelvic fracture treated with INFIX: a case series. J Orthop Trauma 29(3):138–143. https://doi.org/10.1097/bot.0000000000000193
Chiu FY, Chuang TY, Lo WH (2004) Treatment of unstable pelvic fractures: use of a transiliac sacral rod for posterior lesions and an external fixator for anterior lesions. J Trauma 57(1):141–144 (discussion 144–145)
Hao T, Changwei Y, Qiulin Z (2009) Treatment of posterior pelvic ring injuries with minimally invasive percutaneous plate osteosynthesis. Int Orthop 33(5):1435–1439. https://doi.org/10.1007/s00264-009-0756-7
Smith A, Malek IA, Lewis J, Mohanty K (2017) Vascular occlusion following application of subcutaneous anterior pelvic fixation (INFIX) technique. J Orthop Surg (Hong Kong). https://doi.org/10.1177/2309499016684994
Choy WS, Kim KJ, Lee SK, Park HJ (2012) Anterior pelvic plating and sacroiliac joint fixation in unstable pelvic ring injuries. Yonsei Med J 53(2):422–426. https://doi.org/10.3349/ymj.2012.53.2.422
Yinger K, Scalise J, Olson SA, Bay BK, Finkemeier CG (2003) Biomechanical comparison of posterior pelvic ring fixation. J Orthop Trauma 17(7):481–487
Collinge C, Coons D, Aschenbrenner J (2005) Risks to the superior gluteal neurovascular bundle during percutaneous iliosacral screw insertion: an anatomical cadaver study. J Orthop Trauma 19(2):96–101
Bi C, Wang Q, Nagelli C, Wu J, Wang Q, Wang J (2016) Treatment of unstable posterior pelvic ring fracture with pedicle screw-rod fixator versus locking compression plate: a comparative study. Med Sci Monit Int Med J Exp Clin Res 22:3764–3770
Saiki K, Hirabayashi S, Horie T, Tsuzuki N, Inokuchi K, Tsutsumi H (2002) Anatomically correct reduction and fixation of a Tile C-1 type unilateral sacroiliac disruption using a rod and pedicle screw system between the S1 vertebra and the ilium: experimental and clinical case report. J Orthop Sci Off J Jpn Orthop Assoc 7(5):581–586. https://doi.org/10.1007/s007760200104
Tile M (1988) Pelvic ring fractures: should they be fixed? J Bone Jt Surg Br 70(1):1–12
Tornetta P 3rd, Matta JM (1996) Outcome of operatively treated unstable posterior pelvic ring disruptions. Clin Orthop Relat Res 329:186–193
Majeed SA (1989) Grading the outcome of pelvic fractures. J Bone Jt Surg Br 71(2):304–306
Scheyerer MJ, Zimmermann SM, Osterhoff G, Tiziani S, Simmen HP, Wanner GA, Werner CM (2014) Anterior subcutaneous internal fixation for treatment of unstable pelvic fractures. BMC Res Not 7:133. https://doi.org/10.1186/1756-0500-7-133
Dienstknecht T, Berner A, Lenich A, Zellner J, Mueller M, Nerlich M, Fuechtmeier B (2011) Biomechanical analysis of a transiliac internal fixator. Int Orthop 35(12):1863–1868. https://doi.org/10.1007/s00264-011-1251-5